SAN FRANCISCO – Complications developed with 3% of 298 intracranial pressure monitors inserted by trauma surgeons and with 0.8% of 112 monitors placed by neurosurgeons in patients with traumatic brain injury, a statistically insignificant difference.
Mortality rates were 37% for patients in the trauma surgeon group and 30% for patients in the neurosurgeon group, a difference that also was not significant, Dr. Sadia Ilyas and her associates reported at the annual meeting of the American Association for the Surgery of Trauma.
They retrospectively studied data for patients with traumatic brain injury (TBI) who received intracranial pressure monitors in 2006 through 2011 at one Level I trauma center. The trauma surgeons there had undergone training and credentialing in 2005 by neurosurgeons at the same facility for insertion of the monitors because neurosurgery coverage is not always available, explained Dr. Ilyas of Wright State University, Dayton, Ohio.
Complications in this series consisted of device malfunction or dislodgement, with no major or life-threatening complications.
Trauma surgeons in the training program each viewed two 10-minute instructional videos, were proctored by a neurosurgeon in a cadaver lab, and placed three monitors in patients under proctoring by a neurosurgeon. General surgery residents received similar training but were not credentialed to place intracranial pressure monitors without direct supervision.
Guidelines from the Brain Trauma Foundation recommend intracranial pressure monitoring in patients with severe TBI who have a Glasgow Coma Scale score of 8 or lower and an abnormal CT scan. Monitoring typically involves placement of a ventriculostomy or an intracranial pressure intraparenchymal monitor (bolt monitor).
In the study, 97% of all monitors placed were parenchymal monitors. Among those placed by neurosurgeons, 12% were ventriculostomies, which have the added advantage of therapeutic use but are more challenging to insert. "It is our view that placement of ICP parenchymal monitors is a more reasonable alternative for non-neurosurgeons," she said.
Six previous studies of 904 intracranial pressure monitors inserted by non-neurosurgeons found complication rates of 0%-8% with parenchymal monitors and 15% with ventriculostomy.
Each year in the United States approximately 200,000 people are hospitalized for TBI and 50,000 die from TBI. In 2010, an estimated 4,400 neurosurgeons were actively practicing in the United States (1.4 for every 100,000 residents), not all practiced trauma care, and a third were older than 55 years, she said.
Dr. Ilyas reported having no financial disclosures.
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